Iris Kanera

5 127 Lifestyle-related effects of the Kanker Nazorg Wijzer the topic diet very extensively, and which were distributed to all IC-participants. The module Diet was followed by more than 60% of the participants, which suggests that this module was popular, and possibly not only visited based on the provided recommendation, but also based on self-selection. Those, who followed the module Diet, had a higher increase in fruit and fish consumption. A possible explanation for the effect on fish consumption might be attributed to an increase in knowledge about the health advantages of consuming fatty fish, and that consuming fatty fish twice a week may be a healthier choice than eating red and processed meat on daily basis. With regard to the effect on fruit consumption, higher increases in fruit consumption on daily basis might be easier to achieve than changes in other diet habits. Furthermore, it was not possible to choose more than two goals within the module Diet, which resulted in the lower numbers of participants who set goals on the specific dietary outcomes. This might be an explanation for the non-significant results after correction for multiple testing. The effect size for changes in vegetable consumption ( d = .37) in the present study was in line with the effect size of a Dutch web-based, computer tailored, diet-only education intervention for adults in the general population ( d = .32; Springvloet, Lechner, de Vries, & Oenema, 2015). Also Goode et al. (2015) reported comparable effect sizes ( d = .16 to d = 1.71) for non-face-to-face interventions on fruit and vegetable outcomes. Most of these reported studies included intensive (telephone) counseling for cancer survivors. In contrast, the module Diet included less separate sessions, however, showed comparable outcomes. In addition, the web-based multiple behavior intervention for cancer survivors reported by Bantum et al. (2014) was not effective in changing dietary behavior, although not accounting for multiple testing. Parsons et al. (2008) also reported significant changes in vegetable consumption, but not in other dietary behaviors, six months after diet telephone counseling among prostate cancer patients. Notably, the average consumption of vegetables, fruit, and whole grain bread were below recommended levels among the whole sample at both time points. These results confirm findings from research among Dutch cancer survivors, reporting that only 27.4% has met the vegetable recommendations (Kanera et al., 2016a). Additionally, a low overall intake of healthy food has been reported in several studies (Blanchard et al., 2008; Vijayvergia & Denlinger, 2015; Zhang et al., 2015). At the same time, recent observations revealed that particularly early cancer survivors were more likely to meet the vegetable and fruit recommendations (Bluethmann et al., 2015; LeMasters et al., 2014). Still, as our results suggest, there is a lot of room for improvement in dietary behaviors among cancer survivors, and intervening shortly after completing primary treatment seems to be a very relevant period and apparently a teachable moment.